Teens and DUI: Many Factors Increase Risk

Family use also plays role, study found

Action Points

Positive beliefs about marijuana and the ability to resist marijuana in early adolescence had a strong association with DUI and riding with a drinking driver (RWDD) about 4 years later.

At age 14, youths with more past month alcohol (A) use, positive beliefs about marijuana (M), exposure to peer AM use, and family marijuana use had higher risk of DUI/RWDD at age 16.

Positive beliefs about alcohol and marijuana predicted DUI for younger adolescents, while peer exposure was a stronger indicator for older adolescents, according to the results of a small longitudinal survey of California high school students.

Brett A. Ewing, MS, of the RAND Corporation in California, and colleagues found that for 12-year-olds (early middle school), positive beliefs about marijuana (OR 1.63, 95% CI 1.20-2.20) as well as belief in one's ability to resist marijuana use (OR 1.89, 95% CI 1.22-2.92, P<0.001 for both) were associated with increased risk of driving under the influence/riding with a drinking driver (DUI/RWDD) at age 16.

But by age 14 (late middle school), both peer exposure (OR 2.41, 95% CI 1.28-4.53, P<0.001) and past month alcohol use (OR 2.10, 95% CI 1.07-4.11, P<0.01) more than doubled the risk of DUI/RWDD, they reported in Pediatrics.

In addition, family members using marijuana (OR 1.54, 95% CI 1.12-2.11), as well as positive beliefs about marijuana (OR 1.67, 95% CI 1.31-2.13, P<0.001 for both) also predicted subsequent DUI/RWDD for 14-year-olds.

"In this case, youth expressed if they had to stop using marijuana that they had confidence in their ability to stop, although they were not necessarily willing to stop their use," they wrote.

While not involved with the study, Seth Ammerman, MD, medical director of Teen Health Van and clinical professor at Stanford Children's Health, called it "compelling" in its assessments of the attitudes and beliefs of adolescents about alcohol and marijuana over time.

"A key conclusion is that education concerning the risks of alcohol and marijuana use for youth needs to start by age 12 if not sooner, to help prevent the serious and preventable problems associated with teen DUI/RWDD," he told MedPage Today via e-mail.

Co-author Elizabeth D'Amico, PhD, also of the RAND Corporation, agreed, as she emphasized the role that clinicians could play in identifying youth who are the most at risk for alcohol and substance use.

"It is very important to screen youth at all ages for alcohol and drug use in primary care settings, to talk with youth about the choices that they are making, and help youth think about how to make healthy choices during adolescence," she said in an e-mail to MedPage Today. "It is also important to refer youth who may need additional help."

While not statistically significant, the authors found that greater parental respect among 12-year-olds had a protective effect against subsequent DUI/RWDD (OR 0.54, 95% CI 0.31-0.94).

Researchers surveyed small groups from 16 Los Angeles high schools who were participating in the CHOICE program, which was designed to prevent substance use. From 2009 to 2013, two groups of students were surveyed at age 12 or 14, and then again at 16 (n=1,124 and n=972 for early and late middle school students, respectively). Demographic characteristics of the sample included 43.3% boys, 49.6% Hispanic (with 24.1% white and 13.7% Asian). Mean ages were 12.2 (SD=0.7), 14.3 (SD=0.8), and 16.3 (SD=0.7). In 2013, when the final survey was conducted, 88% of the sample was of legal driving age.

Limitations to the study include that the data was self-reported, and that the survey did not ask about alcohol and marijuana use separately in relation to DUI/RWDD.

D'Amico said that further research was needed about the effects of alcohol and marijuana use separately on DUI/RWDD, but reiterated that early intervention about substance use is key to prevention of later unsafe driving practices.

"We need to target youth in middle school and start the discussion early with youth on how to make healthy choices," she concluded. "In addition, given recent changes in legislation in several states, research must begin to focus on the difference between DUI/RWDD of alcohol versus marijuana."

This study was supported by grants from the National Institute on Alcohol Abuse and Alcoholism.

The authors indicated they have no potential conflicts of interest to disclose.

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